Insights in Neurosurgery

Intra thoracic extra pulmonary supra apical tuberculoma in Pott's disease: A case report and review of literatures

Background: Spinal tuberculosis is one of the commonest forms of skeletal tuberculosis in India. It accounts for about 50 % of osteo-articular tuberculosis. Spinal tuberculosis causes significant morbidity in Indian Population. Often patients present with Pott’s disease related paraplegia attended by "destruction of vertebral body, lamina, pedicle and spinous process with perivertebral abscess". Huge intra-thoracic extra-pulmonary extra-plural supra- apical tuberculoma due to extension of spinal tuberculosis is not reported yet. We describe here such a case of complete paraplegia with huge chest mass and its successful management.

Case Description:  A 20 years young male presented with upper thoracic Pott’s paraplegia showing involvement of D1-D3 vertebra with their left pedicle , part of lamina , costo-vertebral and costo-transverse joint with a huge intra thoracic extra-pulmonary supra apical granular tuberculoma mimicking apical tumor. The patient was managed by a posterior “T” shaped vertical midline approach with debridement and decompression of spinal cord and excision of intra thoracic supra apical tuberculoma extra-pleurally. He was administered ATT perioperatively. Postoperatively he followed up for 1 year and now able to walk, run and play normally as before.

Conclusion: Pott’s spine may present with intra-thoracic extra-pleural mass which can be managed by posterior costo-transversectomy and laminectomy. So proper assessment of disease and early need full surgical intervention with anti tubercular therapy can control severe morbidity and disability.

Author(s):

Pratap Chandra Nath*, Manmath Kumar Dhir, Soubhagya Ranjan Tripathy, Somnath Prasad Jena

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